HomeMy WebLinkAbout1254 Declaration of Domicile and Ci~izenship
24241'7
TO THE STATI: ANU ('OUNTY TAX ASSESS~R,
St. Lucie____ _ _ _ _ ('OUNTY, FLORIUA:
This is my drelar~tion oi' Domicilr and Citizrnship in the Statc of Florida that [ am filing this day in
arcor~iancr, and in conforniity with Se~tion _"_?.17, Florida Statut~s. `
1 was fonnerly a tegal r~sidrnt ot' _ Tomat}awk Wisconsin___y_ ~
1(titYl - - (Stale)
r~si~icd at Rt 3 Box 54487 _ _ Howcver, I have changed my domicile to ~
(Strrrl anJ Numbrr)
and am and have br~ n a bona fidr residrnt ot~ the State of Florida since I S t _ day oi~
November 72 Rt 2 Box B 17 Venture Out
- - - . 1 n _ _ _ , and I reside at - - -
(Sttect and Number)
Ft. Pierce Fla. St. Lucie County, Florida,
- - - - - - - •
~c~~.~~ - -
~nd this statemeitt is to be tak~n as my declaration of ~itizenship, actuat legal residence and domicile in the State
of Florida.
(Insrr~ hrrr any prrt~nrnt farts, such u salr of pruperly or businrsc, or relinyuishment of emploYment at fotmer
domicile, remo~al ut famii~• to new domicife, purcAase of hume, rtc.1
Establishing resiiience
z~241'~
FILEO AhD REC~RDEO ~
ST. I,UCt~ ;~~~{~Tr FLA.
QOGEF P~lTRAS
c~EaK c+'CUIT ~OURT
p~r.~F~ v~ =~Ft-D_._~-
No~ 21 I os PN'~Z ~
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I FURTHER CERTIFY that I will re~ister at my locat addnss whrn [he rcgistration books reopen, and
~ comply with all other requirements of a legal msident of this State. _
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; 1 FURTHER CERTIFY that I ha~•e no intention to return to my former domicile, and 1 intend to remain in
~
j Ft. Pierce St. Lucie County,
~ Ftorida, permanently. ~r~~>~~- -
r •~~i~ _~J! ' - , r `
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F l/~u~ ~C/ !
E . j'" ~ ~ - - j
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oTe1 _ ~t;~ ~ Gzlbert Van ?~e~i ' .
. . ~ . ~ . .
f = _ • f..'J' ~ ~ _ :
~ = r U p L L 487irK3C~) ?
; " ~ = Jeannette ~Willigen ~
~~ivorc~-to i~tl,~~t~bscribrd brfore me this 1-- day of
~ ~ ~ p \ 0 .
, ,
~ "`~~November A.D. 19_72--
~ .
"-~c~-
i Notary Public State of Flotida at Large _
s / / ?
My Commission expires` - - _ -
~ ~ ~
(T 4e rxeculyd in duplicatr rnd otiRinal filyd acith Clerk Circui~ Court, and dupii. ate Hith Tax Aasesso~)
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a~ 208 ~~1254
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